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Recommendation for hygiene and topical in neonatology from the French Neonatal Society

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Abstract

We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Réflexion et d’Evaluation de l’Environement des Nouveau-nés (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants.

Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients.

What is known:

• Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide.

• There is no current guideline on hygiene for preterm or hospitalized term newborn.

What is new:

• The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence.

• Caregivers should be aware of the many issues related to hygiene care of newborns including newborns’ behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence.

• Caregivers should be aware of the many issues related to hygiene care of newborns including newborns’ possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.

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Fig. 1
Fig. 2

Abbreviations

LE:

Level of evidence

TEWL:

Transepidermal water loss

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Author information

Authors and Affiliations

  1. Unité de Néonatalogie Soins Intensifs-Pédiatrie de Maternité, Centre Aliénor d’Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France

    Laurent Renesme

  2. Port Royal Assitance Publique Hôpitaux de Paris, Paris, France

    A. Allen, M. Touzet & E. Zana-Taieb

  3. Centre Hospitalier Universitaire de Grenoble, Grenoble, France

    F. Audeoud

  4. Association SOS Préma, Boulogne-Billancourt, France

    C. Bouvard & A. Reynaud

  5. Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France

    A. Brandicourt

  6. Centre Hospitalier Universitaire de Toulouse, Toulouse, France

    C. Casper & V. Pelofy

  7. Centre Hospitalier Inter-Communal de Créteil, Créteil, France

    L. Cayemaex

  8. Centre Hospitalier du Mans, Le Mans, France

    H. Denoual

  9. Centre Hospitalier Universitaire de Besançon, Besançon, France

    M. A. Duboz & G. Thiriez

  10. Comité Inter-Associatif de la Naissance, Paris, France

    A. Evrard

  11. Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France

    C. Fichtner

  12. Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland

    C. J. Fischer-Fumeaux

  13. Association Co-Naître, Pertuis, France

    L. Girard & S. Legouais

  14. Centre Hospitalier Universitaire de Lyon, Lyon, France

    F. Gonnaud, E. Laprugne-Garcia & J. C. Picaud

  15. Hôpital Saint-Pierre Bruxelles, Brussels, Belgium

    D. Haumont

  16. Centre Hospitalier Universitaire de Genève, Genève, Switzerland

    P. Hüppi

  17. Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France

    N. Knezovic, C. Zores & P. Kuhn

  18. Centre Hospitalier Universitaire de Limoges, Limoges, France

    F. Mons

  19. Centre Hospitalier Régional Universitaire de Lille, Lille, France

    V. Pierrat & P. Truffert

  20. Centre Hospitalier Universitaire de Rennes, Rennes, France

    P. Pladys

  21. Agence Régionale de Santé Centre, Orleans, France

    G. Souet

  22. Centre Hospitalier Universitaire d’Amiens, Amiens, France

    P. Tourneux

  23. Centre Hospitalier Général de Valenciennes, Valenciennes, France

    C. Zaoui

  24. Centre Hospitalier Universitaire de Brest, Brest, France

    J. Sizun

Authors
  1. Laurent Renesme
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  2. A. Allen
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  3. F. Audeoud
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  4. C. Bouvard
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  5. A. Brandicourt
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  6. C. Casper
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  7. L. Cayemaex
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  8. H. Denoual
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  9. M. A. Duboz
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  10. A. Evrard
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  11. C. Fichtner
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  12. C. J. Fischer-Fumeaux
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  13. L. Girard
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  14. F. Gonnaud
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  16. P. Hüppi
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  17. N. Knezovic
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  18. E. Laprugne-Garcia
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  19. S. Legouais
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  20. F. Mons
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  21. V. Pelofy
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  22. J. C. Picaud
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  25. A. Reynaud
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  26. G. Souet
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  27. G. Thiriez
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  28. P. Tourneux
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  29. M. Touzet
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  30. P. Truffert
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  31. C. Zaoui
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  32. E. Zana-Taieb
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  33. C. Zores
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  34. J. Sizun
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  35. P. Kuhn
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Contributions

L. Renesme selected and reviewed the articles, and wrote, drafted, and reviewed the manuscript. The members of the GREEN committee listed in the appendix participated in the assignment of level of evidence and reviewed the manuscript.

Corresponding author

Correspondence to Laurent Renesme.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Communicated by Patrick Van Reempts

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All the authors are members of the GREEN study group from the French Neonatal Society.

Appendix. Groupe de Réflexion et d’Evaluation de l’Environnement des Nouveau-nés (GREEN) de la Société Française de Néonatalogie (SFN).

Appendix. Groupe de Réflexion et d’Evaluation de l’Environnement des Nouveau-nés (GREEN) de la Société Française de Néonatalogie (SFN).

GROUPE DE REFLEXION ET D’EVALUATION DE L’ENVIRONNEMENT.

DES NOUVEAU-NES (GREEN) DE LA SOCIETE FRANCAISE DE.

NEONATALOGIE (SFN):

  • Aurore Allen (Port Royal-Paris)

  • Frédérique Audeoud (CHU Grenoble)

  • Charlotte Bouvard (SOS Préma)

  • Anne Brandicourt (CH Sud Francilien)

  • Charlotte Casper (CHU Toulouse)

  • Laurence Cayemaex (CHIC Créteil)

  • Héléne Denoual (CH Le Mans)

  • Marie Agnès Duboz (CHU Besançon)

  • Anne Evrard (Comité Inter-Associatif de la Naissance)

  • Christine Fichtner (CHU Saint-Etienne)

  • Céline J. Fischer-Fumeaux (CHUV Lausanne)

  • Laurence Girard (Association Connaître)

  • Françoise Gonnaud (CHU Lyon)

  • Dominique Haumont (Hôpital Saint-Pierre Bruxelles)

  • Petra Hüppi (CHU Genève)

  • Nadine Knezovic (CHU Strasbourg)

  • Pierre Kuhn (CHU Strasbourg)

  • Elisabeth Laprugne-Garcia (CHU Lyon)

  • Sophie Legouais (Paris)

  • Fabienne Mons (CHU Limoges)

  • Valérie Pelofy (CHU Toulouse)

  • Jean-Charles Picaud (CHU Lyon)

  • Véronique Pierrat (CHU Lille, Inserm EPopé)

  • Patrick Pladys (CHU Rennes)

  • Audrey Renaud (SOS préma)

  • Laurent Renesme (CHU Bordeaux)

  • Jacques Sizun (CHU Brest)

  • Gilles Souet (ARS Centre)

  • Gérard Thiriez (CHU Besançon)

  • Pierre Tourneux (CHU Amiens)

  • Marie Touzet (Hôpital de Port-Royal, Paris)

  • Patrick Truffert (CHU Lille)

  • Catherine Zaoui (CHG Valenciennes)

  • Elodie Zana-Taieb (Hôpital de Port-Royal)

  • Claire Zores (CHU Strasbourg)

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Renesme, L., Allen, A., Audeoud, F. et al. Recommendation for hygiene and topical in neonatology from the French Neonatal Society. Eur J Pediatr 178, 1545–1558 (2019). https://doi.org/10.1007/s00431-019-03451-3

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